Training of clinical psychologists on an unsure footing in Estonia

Although Estonia faces a significant shortage of clinical psychologists, their training has yet to receive sustainable funding. For instance, trainees cannot afford to take extended sick leave or parental leave during their professional year and those aspiring to become psychotherapists must be prepared to pay over €6,000 out of their own pockets.
Estonia continues to face a shortage of clinical psychologists, with appointment wait times significantly longer than in neighboring countries. According to a labor market forecast published by the Estonian Qualifications Authority last year, the number of clinical psychologists currently being trained is far below what the job market will require in the coming years.
Although the government has taken additional steps in recent years to train more psychologists, the training of clinical psychologists — spanning over six years, including additional qualifications — still lacks sustainable funding.
Iiris Velling, vice chair of the Estonian Association of Clinical Psychologists, is herself a clinical child psychologist. There are fewer than 50 child psychologists in all of Estonia.
"At present, people are not motivated to pursue a career in child psychology under the current training framework. If this continues, I don't see the number of child psychologists increasing," Velling explained.
The challenges psychologists face stem primarily from the professional year requirement, a prerequisite for earning a clinical psychologist qualification. Similar to medical residency, this professional year follows a five-year master's program.
Since 2021, the professional year has been funded by the state budget. Before that, trainees were entirely responsible for covering the costs themselves. However, the professional year is still not part of the formal clinical psychology curriculum; instead, the state finances training annually through tenders.
For the current academic year, for instance, the University of Tartu received €820,000 from the state to train 15 clinical psychologists.
Kirsti Akkermann, head of clinical psychology at the University of Tartu, said that this form of funding poses challenges for both students and the university. For example, the annual tender does not allow trainees to take extended sick leave or parental leave, as this would disrupt their professional year.
"If someone is expecting a child and takes parental leave, they cannot simultaneously work because Estonian law does not allow it, nor would it be practical for the child or the mother. Our training period runs from September 1 to August 31. If the period ends, they cannot return because there is no guarantee that funding for the professional year will be available the following year. Even if the professional year is re-tendered, the individual cannot simply resume their studies, as new candidates are already competing for those spots," Akkermann explained.
She added that the current tender-based funding model also prevents part-time training or spreading out the workload of the professional year, as is possible in medical residency programs.
Six days a week for €1,500
Organizing tenders annually also creates challenges for universities, as they lack certainty about whether or to what extent the professional year will be funded in future years.
"For example, the ministry has informed us that this year there will be a tender. However, I already need to start negotiating with employers, identifying potential supervisors and assessing the needs of healthcare institutions. The whole process is unstable for us. Sometimes the tender is announced as late as the end of May or the beginning of June and we are expected to conduct entrance exams and start the academic year by September 1," explained Akkermann.
The professional year is structured so that trainees spend four days a week in a healthcare institution, such as a hospital, gaining practical experience. The fifth day is allocated for academic study, which often requires traveling to the University of Tartu.
Iiris Velling pointed out another issue: trainees are only paid for 0.8 of a full-time workload, meaning the day designated for academic study is not funded. Since the salary is based on the national average wage in Estonia, it amounts to approximately €1,500 per month.
"If someone works four days a week in Tallinn, for example, they must cover their own transportation costs to travel to Tartu for academic studies on Fridays. That study day is unpaid. This is extremely unfair when you consider that they are only compensated for 0.8 of a full-time workload. In reality, their actual workload is closer to six working days per week, as the study day in Tartu is supplemented by independent study at home," Velling said.
Ministry offers no rapid solutions
Anne Randväli, head of the Ministry of Social Affairs' mental health department, acknowledged that the current tender system is not an ideal or sustainable solution, but it is what the state has been able to manage for now.
She was, however, unaware that the tender system effectively prevents trainees from taking extended sick leave or parental leave.
Randväli explained that until 2021, the funding of psychologists' qualifications was entirely the responsibility of the individual. The tender-based organization of the professional year was initially conceived as a temporary solution to address a pressing societal issue.
In the long term, she noted, the professional year for psychologists — at least for clinical psychologists — should be integrated into the regular education system, similar to medical residency programs.
"The ministry has already taken steps in this direction and initial discussions with universities have begun," Randväli said.
Vootele Veldre, an adviser to the deputy secretary general for health, stated that the Ministry of Social Affairs, in collaboration with the Ministry of Education and Research, plans to restart discussions about the professional year in the second half of the year.
"Since there are several potential ways to move forward, we unfortunately cannot offer quick solutions. With constructive cooperation, the earliest possible implementation of regulatory changes would be the 2027/2028 academic year," Veldre said.
He added that several other professions, such as creative therapists, are also interested in adopting a similar professional year model. Therefore, addressing the regulation of the professional year would not only solve the training issues for clinical psychologists but also benefit other fields.
Psychotherapists often pay €,6000 out of pocket
The challenges surrounding the professional year for clinical psychologists are not the only issues related to the training of psychologists in Estonia. Another pressing question arises about what happens after the qualification is obtained, particularly for those who wish to specialize in a more specific field.
Clinical psychologists can specialize in areas such as child psychology, psychotherapy, forensic and correctional psychology or neuropsychology.
According to Iiris Velling, the six-year process of obtaining a clinical psychology qualification is insufficient for competently addressing children's issues. "Child psychology is a very specific field," she emphasized.
Velling explained that additional training in child psychology requires a practitioner to complete 400 supervised working hours under a child psychologist and an additional 390 academic hours of specialized coursework.
While it may be possible to negotiate payment for the working hours and supervision with employers, such as hospitals, the academic coursework often requires the individual to cover most of the expenses personally.
Velling calculated that the cost of completing the coursework required to earn a child psychology qualification currently amounts to around €1,300 at the University of Tartu. In contrast, obtaining a five-year clinical psychotherapy qualification costs over €6,000.
"On top of this, there are international training programs and conferences, where a single day can cost between €100 and €200. This process is extremely expensive for individuals," Velling noted.
She added that in hospitals, the level of personal financial contribution required from psychologists often depends on the hospital's budget and how much funding is allocated for psychologist training.
"A few years ago, we were able to offer free training thanks to a Norwegian grant project. However, that funding is no longer available and the amount hospitals can afford to pay from their budgets is very minimal," Velling said.
Anne Randväli acknowledged the concern that specialization beyond the professional year is largely financed by either the individual or their employer.
"What I can say is that we are taking things step by step. We have managed to secure funding for the professional year and the next step is to develop a sustainable solution for it. From there, we will move forward," Randväli stated.
Qualifications Authority: Not enough clinical psychologists trained
According to statistics from the National Institute for Health Development, 183 clinical psychologists were employed in Estonia's healthcare institutions as of November 2023.
As of May 2024, 362 individuals held the level seven clinical psychologist qualification, while eight held the level eight qualification. These qualifications are issued by the Estonian Association of Psychologists and require successful completion of a specialized master's degree along with a professional year that includes specialization courses and supervised practice.
A labor market study on the healthcare sector, published last year by the Qualifications Authority, highlighted the significant demand for clinical psychologists in the coming years. The report suggested doubling the number of trainees admitted to the professional year annually — from the current 15 to as many as 30. However, the study also noted that even this increase might not be sufficient to meet future demand.
Under the Health Services Organization Act, clinical psychologists are equated with healthcare professionals if they provide treatment and are registered in the healthcare information system.
In March 2023, the average gross monthly salary for clinical psychologists in healthcare was €2,846.
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Editor: Urmet Kook, Marcus Turovski